Basic Information
Provider Information
NPI: 1265600753
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MURRAY
FirstName: AARON
MiddleName: TIMOTHY
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9007
Address2:  
City: SPRINGFIELD
State: MO
PostalCode: 658089007
CountryCode: US
TelephoneNumber: 4178753000
FaxNumber:  
Practice Location
Address1: 525 BRANSON LANDING BLVD
Address2:  
City: BRANSON
State: MO
PostalCode: 656162052
CountryCode: US
TelephoneNumber: 4173357000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/19/2008
LastUpdateDate: 08/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X49926COY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
20009682405MO MEDICAID


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